71

71 Rev.xls

Importation of Lemons from Northwest Argentina

71

OMB: 0579-0448

Document [xlsx]
Download: xlsx | pdf





















INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.







TITLE OF INFORMATION COLLECTION DOCUMENT



OMB NO.



































Importation of Lemons from Northwest Argentina 0579-XXXX














































DATE PREPARED








































May 5, 2016



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





Docket No. APHIS 2014-0092








































REPORTS



RECORDS










































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION



(If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B)



(C) (D) (E) (F) (G) (H) (I) (J) (K)





319.56.73(a)(1) Workplan - foreign officials (foreign gov't) None 1 1.0000 1.00 80.0000 80.00








319.56.73(a)(2) Production Site Registration (business) None 25 1.0000 25.00 0.5000 13.00








319.56.73(a)(2) Production Site Registration (foreign gov't)(same) None 1 25.0000 25.00 0.2500 6.00








319.56.73(a)(3) Packinghouse Registration (business) None 49 1.0000 49.00 0.5000 25.00








319.56.73(a)(3) Packinghouse Registration (foreign gov't)(same) None 1 49.0000 49.00 0.2500 12.00








319.56.73(a)(4) Recordkeeping (foreign gov't)(same) None




1 5.000 5.00












75
149.00
136.00 1.00
5.00












76
4,040.00
315.00




























































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.







TITLE OF INFORMATION COLLECTION DOCUMENT



OMB NO.




































Argentine Lemons


0579-XXXX





























































DATE PREPARED








































January 5, 2016



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





ANNUAL BURDEN








































REPORTS



RECORDS










































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION



(If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B)



(C) (D) (E) (F) (G) (H) (I) (J) (K)





319.56.73(a)(6) Identification of lots (business) (same) None 49 70.0000 3,430.00 0.0006 2.00








319.56.73(a)(7) 305.6(a) Cold Treatment Requirements for Fruit Flies (business) None 1 1.0000 1.00 0.0040 0.50








305.6(a) Facility Certification (business) None 1 1.0000 1.00 0.0040 0.50








305.6(d)(6) Numvered Seals (business) (same) None 1 100.0000 100.00 0.0040 1.00








305.6(d)(12) Record Review/Treatment (business) (same) None 1 20.0000 20.00 0.2500 5.00








305.6(d) (14) Audits (business) (same) None 1 50.0000 50.00 0.5000 25.00









SUBTOTAL




1
3,602.00
34.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.







TITLE OF INFORMATION COLLECTION DOCUMENT



OMB NO.




































Lemons from Argentina


0579-XXXX





























































DATE PREPARED








































January 5, 2016



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





ANNUAL BURDEN








































REPORTS



RECORDS










































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION



(If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B)



(C) (D) (E) (F) (G) (H) (I) (J) (K)





305.6(e ) Monitoring (business) (same) None 1 50.0000 50.00 0.2500 25.00







1
319.56.73(b)(1) Pest Free Determination of Production Site Biometric Determination (foreign gov't)(same) None 1 50.0000 50.00 0.5000 25.00








319.56.73(b)(3) Monitoring of traps and Recordkeeping (foreign gov't) (same) None 1 50.0000 50.00 0.2500 13.00 1 0.200 1.00





319.56.73(b)(5) Production Site Inspections and Recordkeeping (business)(same) None 25 1.0000 25.00 1.0000 25.00 25 0.200 5.00





319.56.73(b)(5) Production Site Inspections and Recordkeeping foreign gov't) (same) None 1 25.0000 25.00 1.0000 25.00 1 0.200 1.00





319.56.73 (b) (6) Recertification of Production Site (foreign gov't)(same) none 1 1.0000 1.00 0.5000 1.00








319.56.73 (c ) Recertification of Packinghouse (foreign gov't)(same) none 1 1.0000 1.00 0.5000 1.00









SUBTOTAL




0
202.00
115.00 27
7.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.







TITLE OF INFORMATION COLLECTION DOCUMENT



OMB NO.








































0579-XXXX





























































DATE PREPARED





































































IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT





ANNUAL BURDEN








































REPORTS



RECORDS










































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION



(If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B)



(C) (D) (E) (F) (G) (H) (I) (J) (K)





319.56.73(a)(9) Phytosanitary Certficates (business)(same) None 30 1.0000 30.00 0.5000 15.00

























319.56.73(a)(9) Phytosanitary Certficates (business)(same) None 1 30.0000 30.00 0.5000 15.00








































































SUBTOTAL






60.00
30.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00




































































INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
TITLE OF INFORMATION COLLECTION DOCUMENT OMB NO.




















0581-






















DATE PREPARED



























IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT
ANNUAL BURDEN



















REPORTS RECORDS
































TOTAL











FORMS NO (S) NO. OF NO OF TOTAL ANNUAL HOURS TOTAL NO. OF ANNUAL RECORD-





SECTION OF DESCRIPTION (If "none" RESPONDENTS RESPONSES RESPONSES PER HOURS RECORD- HOURS PER KEEPING HOURS





REGS.




so state)
PER (Col. D x E) RESPONSE (Col. F x G) KEEPERS RECORD- (Col. I x J)













RESPONDENT



KEEPER






(A) (B) (C) (D) (E) (F) (G) (H) (I) (J) (K)










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00










0.00
0.00

0.00






SUBTOTAL


0.00
0.00 0
0.00





File Typeapplication/vnd.ms-excel
Authoruser
Last Modified ByStratchko, Karen A - APHIS
File Modified2016-05-10
File Created2000-01-10

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